Probabilistic cost-minimisation analysis of darbepoetin alpha versus epoetin alpha in treating anaemia secondary to chronic renal failure. Assessment in Spanish clinical practice.

Introduction: The direct transfer of the results of pharmaco-economic studies between countries may not be suitable if the proper adaptations are not made to take into account differences in treatment patterns, resource use and costs from country to country.

Objective: To estimate the cost in Spain of treating anaemia secondary to chronic renal failure with darbepoetin alpha or epoetin alpha from a review and analysis of available current information. In addition, the role of the route of administration as a main driver of the cost will be analysed.

Method: population: patients with chronic kidney failure induced anaemia.

Data: Medline and Embase search of studies directly comparing erythropoiesis stimulating agents.

Analysis: Cost minimization analysis from the perspective of a hospital pharmacy department. The main outcome chosen was the difference between the average cost per patient undergoing a 30-day treatment with epoetin alpha versus darbepoetin alpha.

Results: (a) haemodialysis: changing from epoetin alpha to darbepoetin alpha is associated with a cost reduction of 8.67%; CI 95%, -1.34 to 17.92 (euro 17.48; CI 95%, -2.70 to 36.13); probabilistic analysis showed that the use of darbepoetin alpha could be associated with a cost-saving probability of 94.9%. The IV administration yielded a decrease in costs of about 16.00%; CI 95%, -2.38 to 36.77 (euro 41.78, CI 95%: -6.21 to 96.04). (b) Pre-dialysis: darbepoetin alpha is associated with a cost reduction of about 11-32%.

Conclusions: The use of darbepoetin alpha for the treatment of chronic renal failure induced anaemia (haemodialysis and pre-dialysis) shows higher cost efficiency than epoetin alpha in Spain; these differences increase with IV administration.